Stratified cost-utility analysis of C-Leg versus mechanical knees

Abstract

The stratified cost-utility results have relevant clinical implications and provide useful information for practitioners in tailoring interventions. Clinical relevance A cost-utility analysis that considered patients characteristics provided insights on the "affordability" of C-Leg compared to mechanical knees. In particular, results suggest that C-Leg has a significant impact on "mobility" for first-time prosthetic users over 40 years, but implementation of specific low-cost physical/psychosocial interventions is required to retun within cost-utility thresholds.

Cost-effectiveness and budget impact of the microprocessor-controlled knee C-Leg in transfemoral amputees with and without diabetes mellitus

“…We identified four studies [16][17][18][19] which reported utilities for C-Leg and NMPK users. Three studies [16][17][18] used the EQ-5D 3L and one study [19] the SF-36/SF-6D. Brodtkorb et al [16] derived utility values directly from the visual analog scale of the EQ-5D which is not the standard method for generating utilities and does not reflect preferences of the society.…”

“…Compared with non-microprocessor-controlled (mechanical) knee joints (NMPK), the C-Leg reduced the number and frequency of stumbles and falls of up to 80% [6,8,9]. In addition, four studies [16][17][18][19] that analyzed the health-related quality of life (HRQoL) in prosthesis users found improvements in the HRQoL of 14-38% when patients were using the C-Leg instead of NMPKs.…”

“…Therefore, it is important to investigate whether the price of the C-Leg is justified by the additional benefits. Four studies [16][17][18]20] have assessed the cost-effectiveness of the C-Leg compared to NMPKs. Three studies were from Europe [16][17][18] and one study from the US [20].…”

“…Four studies [16][17][18]20] have assessed the cost-effectiveness of the C-Leg compared to NMPKs. Three studies were from Europe [16][17][18] and one study from the US [20]. Results varied from the C-Leg-dominating NMPKs in a patient cohort with an average age of 45-46 years old (societal perspective) [18] to an ICER of close to 90,000 Euros per quality-adjusted life year (QALY) gained in a cohort of amputees aged 40+ years old at the time of first prosthesis (payer's perspective) [17].…”

“…Three studies were from Europe [16][17][18] and one study from the US [20]. Results varied from the C-Leg-dominating NMPKs in a patient cohort with an average age of 45-46 years old (societal perspective) [18] to an ICER of close to 90,000 Euros per quality-adjusted life year (QALY) gained in a cohort of amputees aged 40+ years old at the time of first prosthesis (payer's perspective) [17]. Only one study included the medical and economic consequences of falling, which had a major impact on the cost-effectiveness of the C-Leg [20].…”